Provider Demographics
NPI:1790096725
Name:TANS, LYNNELLE ANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LYNNELLE
Middle Name:ANN
Last Name:TANS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 ANN ARBOR SALINE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9777
Mailing Address - Country:US
Mailing Address - Phone:616-822-6582
Mailing Address - Fax:
Practice Address - Street 1:6700 BROWNS LAKE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8379
Practice Address - Country:US
Practice Address - Phone:517-768-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105731235Z00000X
MI7101002090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist